Koronarsinusdilatation

Abstract

A 36-year old woman was presented to our hospital with congenital ventricular septal defect and one-vessel coronary artery disease (75% proximal left main coronary artery) for CABG and repair of the VSD. After induction, a transesophageal echocardiographic (TEE) baseline examination was performed, showing a severely dilated coronary sinus (CS) measuring approximately 3 cm (abnormal >1 cm). We suggested a persistent left superior vena cava (PLSVC) draining into the CS. PLSVC is a common venous congenital anomaly, with a reported incidence of 0.5% in general population and in 3-5 % of patients with congenital heart defect. Injection of echo-contrast solution in a left arm vein, visualizing microbubbles passing through the PLSVC into the CS confirmed our suspicion. The diagnosis of a PLSVC and dilated CS is a contraindication for retrograde cardioplegia because of the loss of cardioplegia into the PLSVC resulting in a inadequate myocardial protection. It may be difficult to pass a pulmonary artery catheter (PAC) through a left internal or left subclavian vein and it may be associated with arrhythmias. A chest radiograph shows the anomalous course of the PAC along the left heart.

Coronary sinus dilatation is a sign of impaired right ventricular function in patients with heart failure

“…A dilated CS can result from increased blood flow due to abnormal venous drainage in the left superior vena cava, total anomalous intra-cardiac pulmonary venous drainage, severe tricuspid regurgitation, CS diverticulum, or a coronary artery to CS fistula. The absence of primary abnormalities is generally a manifestation of high RA pressure due to functional tricuspid regurgitation (10-12). Koberstein et al (13) showed that CS dilatation with RA blood reflux to the CS was due to increased RA pressure.…”